PEMBA ON-DEMAND: Real Stories from Physician Leaders

What if one of the most important moments in healthcare happens after a patient leaves the hospital? In this episode of PEMBA On Demand, Dr. Norman Chapin sits down with Dr. Tiffany Hanf, Regional Medical Director for Post-Acute Care at TeamHealth and current PEMBA student, to discuss one of healthcare’s most persistent and costly challenges: helping patients successfully transition from the hospital to post-acute care while reducing preventable readmissions. Dr. Hanf oversees post-acute care operations across nine western states and shares insights from her work leading skilled nursing facilities, long-term care facilities, and rehabilitation programs. At the center of the conversation is her work on an acute-to-post-acute transition program designed to improve coordination, communication, and continuity of care between hospitals and post-acute providers. She explains that one of the biggest barriers to successful transitions is the fragmentation that often exists between hospitals and post-acute facilities. Because these organizations are frequently managed by separate entities, critical information can be lost during the handoff process. Effective discharge summaries, medication coordination, and timely communication are essential to ensuring patients receive seamless care after leaving the hospital. The discussion explores how the role of physicians in post-acute care has evolved significantly over the years. Dr. Hanf explains that modern post-acute medicine requires dedicated physician leadership, advanced practice clinicians, structured rounding models, and specialty support services. The traditional model of infrequent physician visits to nursing facilities has largely been replaced by a more proactive, team-based approach focused on quality outcomes and reducing unnecessary hospitalizations. Dr. Hanf also shares lessons from a collaborative initiative with a health system seeking to address long hospital stays, discharge bottlenecks, and readmissions. Through coordinated partnerships and standardized workflows, her team has demonstrated improvements in transitions of care, reductions in readmissions, and shorter hospital lengths of stay. However, she notes that meaningful change often requires overcoming organizational silos and building trust among multiple stakeholders. A significant portion of the conversation focuses on readmissions from post-acute care settings. Dr. Hanf explains that many readmissions are driven by factors such as infections, sepsis, congestive heart failure exacerbations, falls, inadequate access to diagnostics, staffing challenges, and patient or family decisions to seek emergency care. She emphasizes that successful programs focus on identifying these drivers early and creating systems that allow patients to safely remain in the most appropriate care setting whenever possible. The episode also highlights TeamHealth’s philosophy that clinicians are the organization’s primary customer. Dr. Hanf discusses how supporting physicians and advanced practice clinicians through strong workflows, technology, communication systems, and leadership ultimately improves facility performance and patient outcomes. This clinician-first approach has become a key part of TeamHealth’s strategy for recruitment, retention, and quality improvement. Later in the conversation, Dr. Hanf reflects on her own career journey. After spending more than a decade as a hospitalist, she transitioned fully into post-acute care, drawn by the opportunity to build deeper relationships with patients while maintaining a sustainable work-life balance. She describes post-acute medicine as a unique blend of acute care complexity and long-term patient continuity. Finally, Dr. Hanf shares why she chose to pursue the Physician Executive MBA at this stage of her career. Encouraged by colleagues and mentors, she viewed the program as an opportun...

What if the biggest problem in lung cancer is not treatment, but that patients are diagnosed too late? In this episode of PEMBA On Demand, Dr. Norman A. Chapin speaks with Dr. J. Robert Headrick, Chief of Thoracic Surgery at CHI Memorial Rees Skillern Cancer Institute, about physician leadership, innovation, and transforming how we approach lung cancer and preventive healthcare. Dr. Headrick shares how his journey evolved from traditional surgical practice into a mission-driven focus on early detection, access, and system redesign in lung cancer care. He explains that one of the biggest problems in healthcare today is not a lack of treatment options, but the fact that patients are often diagnosed too late, when symptoms finally appear. The conversation highlights how lung cancer has long been misunderstood as primarily a smoking-related disease, when in reality, many patients, including non-smokers, are affected, and outcomes improve significantly when cancer is detected early. A central focus of the episode is Dr. Headrick’s work in developing mobile CT screening programs, including a bus-based model designed to bring low-dose CT scans directly into communities. He explains that traditional healthcare delivery creates barriers such as time, access, and inconvenience, which prevent many eligible patients from getting screened. By contrast, simplifying access to a quick, minutes-long scan dramatically increases participation. Dr. Headrick shares real-world examples of how this approach is changing outcomes, including communities where people are now living with early-stage lung cancer who would not have been diagnosed otherwise. These success stories demonstrate how visibility, convenience, and trust can shift public perception and engagement with preventive care. The discussion also explores the operational and scalability challenges of this model. While mobile screening improves access, it introduces new complexities such as: Managing large volumes of imaging data Coordinating follow-up care Ensuring patients return for repeat scans Avoiding strain on radiology resources Dr. Headrick explains that these challenges are driving the need for new solutions powered by artificial intelligence, particularly in imaging interpretation and workflow efficiency. AI has the potential to significantly reduce the time required to review scans and help identify early disease patterns more quickly. A major theme of the episode is the shift from reactive healthcare to proactive care. Dr. Headrick emphasizes that relying on symptoms to guide care is fundamentally flawed, especially for conditions like lung cancer and heart disease, which often remain silent until advanced stages. He outlines a broader vision for the future of healthcare that includes: Earlier and more accessible screening Lower-cost, high-efficiency diagnostic tools Integration of AI to support clinical decision-making Empowering patients to engage in their own health earlier in life Dr. Headrick also discusses how his experience in the Physician Executive MBA (PEMBA) program helped him transition from thinking as an individual clinician to thinking at a systems level, including business planning, financial modeling, and leadership strategy. This shift enabled him to bring innovative ideas into real-world implementation. The episode concludes with a powerful perspective on healthcare economics. Dr. Headrick references projections suggesting that moving toward proactive, preventive care could significantly reduce national healthcare spending, while improving patient outcomes and quality of life. Ultimately, this conversation highlights how physician leadership, combined with innovation and system-level t...

What if hospital-level care could safely happen in a patient’s home instead of inside a hospital building? In this episode of PEMBA On Demand, Dr. Norman A. Chapin speaks with Dr. Mihir H. Patel about the growing hospital-at-home movement and what it means for physician leaders, health systems, and patients. Hospital at home refers to acute hospital-level care delivered in a patient’s home instead of a traditional inpatient bed, not simply remote monitoring or home health. The model has gained major momentum in recent years as health systems look for new ways to improve capacity, reduce harm, and deliver care in the right setting. Dr. Patel explains that hospital-at-home programs are designed to address three major challenges in modern healthcare: hospital capacity strain, the risks patients face inside hospitals, and the high cost of brick-and-mortar inpatient care. He walks through the types of diagnoses that often fit the model, including conditions like pneumonia, COPD exacerbations, CHF, cellulitis, UTIs, dehydration, and similar cases where patients need acute treatment but do not require ICU-level care. The conversation also explores how these programs actually work behind the scenes. Dr. Patel describes the mix of physicians, nurses, paramedics, pharmacists, case managers, and logistics teams needed to support care in the home. He and Dr. Chapin discuss how virtual visits, remote monitoring, medication delivery, and rapid-response workflows all play a role in making the model safe and scalable. A major focus of the episode is outcomes. Dr. Patel shares why mature hospital-at-home programs have shown encouraging results in patient safety, patient satisfaction, and readmissions. Public-facing hospital-at-home resources likewise describe the model as a patient-centered alternative that can improve care outcomes for appropriate adults while reducing exposure to hospital-associated complications. Dr. Chapin and Dr. Patel also discuss the business and policy side of the model, including fixed versus variable costs, reimbursement, and the importance of federal waiver support. The CMS Acute Hospital Care at Home waiver was extended for five years through 2030 in March 2026, giving health systems more certainty as they invest in infrastructure and staffing. The AMA reports that the waiver supports hospital-level home care for Medicare patients, and advocacy materials from the Advanced Care at Home Coalition show broad national participation by hospitals and health systems. The episode also highlights the role of technology. Dr. Patel explains how tablets, wireless monitoring devices, ambient AI documentation, and logistics coordination tools are becoming increasingly important in hospital-at-home workflows. He offers a practical look at how these technologies can support earlier intervention, improve efficiency, and help teams manage care across multiple patients and locations. Later in the conversation, Dr. Patel reflects on his own career path and why he chose to pursue the Physician Executive MBA at the University of Tennessee. He shares how the program helped him think beyond individual patient encounters and better understand finance, operations, workflow design, and system-level leadership. He also discusses his work in medical writing and his involvement with The Hospitalist, which is the Society of Hospital Medicine’s monthly newsmagazine. This episode is both a practical overview of hospitals at home and a thoughtful reflection on physician fulfillment. Dr. Patel closes with a powerful reminder that success is not only about titles, income, or credentials. For physicians, real success also means finding a path that supports personal well-being, family life, and meaningful patient care. Key Topics Discussed What hospital at home really means Why health systems are...

What if the skills that make a great physician aren’t enough to lead healthcare, and the real transformation begins when medicine and business finally learn to speak the same language? This recast episode of Pemba on Demand: Leadership Odyssey Bridging Medicine and Business revisits a compelling conversation with host Dr. Norman A. Chapin and Dr. Michael Marks, Senior Medical Director at Relievant Medsystems, Inc. Dr. Marks reflects on his professional journey from orthopedic spine surgeon to healthcare executive in the medical device industry. He shares how his experience in the Physician Executive MBA program at the University of Tennessee shaped his leadership approach, supported complex orthopedic group mergers, and prepared him for roles in hospital administration and industry leadership. The episode explores the evolving identity of physician leaders and highlights the importance of education, mentorship, collaboration, and adaptability when navigating the intersection of medicine and business. Dr. Marks also discusses the human side of leadership, including maintaining empathy in patient care, facing personal health challenges, and advocating for patients within complex insurance and reimbursement systems. Show Highlights Transitioning from clinical practice to executive leadership roles The value of the Physician Executive MBA program for physicians Managing healthcare mergers and navigating cultural integration Empathy and communication as essential leadership skills The role of mentorship in career development and growth Staying connected to clinical care during personal health challenges Advocating for patients amid insurance and coverage barriers Understanding healthcare spending and its impact on Medicare and Medicaid The importance of continuous learning in a changing healthcare landscape Collaboration and shared purpose as foundations of effective leadership Links and Resources: Physician Executive MBA at the University of Tennessee Michael Marks MD MBA

What if the same negotiation skills used to save hostages could help physicians lead better teams, reduce burnout, and transform healthcare from the inside out? In this episode of PEMBA On Demand, host Dr. Norman A. Chapin sits down with Camilo R. Gomez, MD, MBA, and former FBI lead hostage negotiator Christopher Voss to explore how elite negotiation strategies can reshape leadership in healthcare. Drawing from their new book Strategic Conversations, the conversation bridges the worlds of medicine and high stakes negotiation. Dr. Gomez and Christopher Voss explain how principles like tactical empathy, calibrated questions, ethical ambition, and disciplined curiosity can improve physician leadership, strengthen care teams, reduce burnout, and create better outcomes for patients and organizations alike. This episode challenges traditional command and control leadership models and offers physicians a practical framework for navigating conflict, complexity, and change with clarity and confidence. Key Topics Covered Applying FBI hostage negotiation principles to healthcare leadership Tactical empathy as a leadership and communication tool Moving from authority based leadership to influence based leadership Reducing burnout through better conversations and alignment Ethical ambition and its role in modern medical leadership Improving collaboration across care teams and organizations Navigating high pressure conversations with patients and colleagues Building trust and psychological safety in clinical environments Creating sustainable win win outcomes in healthcare systems Guest's Bio: Dr. Camilo R. Gomez, MD, MBA Dr. Camilo R. Gomez is a physician, author, and healthcare executive with a focus on leadership, ethics, and system level improvement. He brings deep experience at the intersection of medicine, strategy, and communication, helping clinicians navigate complex professional environments with clarity and purpose. Christopher Voss Christopher Voss is a former FBI lead international hostage negotiator and the founder of Black Swan Group. He is the bestselling author of Never Split the Difference and a globally recognized expert in negotiation, communication, and decision making under pressure. Links & Resources Dr. Camilo R. Gomez on LinkedIn https://www.linkedin.com/in/neuroranger/ Christopher Voss on LinkedIn https://www.linkedin.com/in/christophervoss/ Organizations Black Swan Group https://www.blackswanltd.com/ Books Mentioned Strategic Conversations by Camilo R. Gomez and Christopher Voss https://www.amazon.com/Strategic-Conversations-Successbooks-Publishing/dp/B0DWH4R21H Never Split the Difference by Christopher Voss https://www.amazon.com/Never-Split-Difference-Negotiating-Depended/dp/0062407805 Empathy and Understanding in Business by Christopher Voss https://www.amazon.com/Empathy-Understanding-Business-Chris-Voss/dp/B0CNF6J4G8 Empathic Reasoning for Extraordinary Results by Christopher Voss https://www.amazon.com/Empathic...

What if reducing emergency department readmissions wasn’t about working harder, but about leading smarter through data, teamwork, and innovation? In this episode of PEMBA On Demand, host Dr. Norman A. Chapin speaks with Dr. Max Baumgardner DO, FACEP, Chief Medical Officer at AdventHealth Apopka and current student in the University of Tennessee Physician Executive MBA program. Dr. Baumgardner shares the transformational journey of leading a multidisciplinary initiative aimed at reducing emergency department readmissions. He explains how his team leveraged data, care coordination, centralized case management, Epic integration, and innovative emergency department interventions to improve patient outcomes and move system performance from bottom quartile to top quartile. Dr. Baumgardner discusses the leadership lessons gained through PEMBA, the power of frontline engagement, and strategies for balancing administrative and clinical responsibilities while creating sustainable, scalable improvement. Key Topics Covered Reducing emergency department readmissions through multidisciplinary collaboration Identifying high risk patients using real world data insights Leveraging Epic tools and alerts to improve care coordination The value of centralized case management and live Epic chat support Innovative emergency department solutions including infusions, dialysis, and direct facility placement Strengthening transitions of care using care plans and team based communication Maintaining quality and performance metrics while implementing major change Leadership strategies for empowering teams and sustaining improvement Balancing clinical work and the Chief Medical Officer role How the PEMBA program accelerated leadership capabilities and project success Links and Resources Dr. Max Baumgardner on LinkedIn https://www.linkedin.com/in/max-baumgardner-do/ ‍⚕️ Dr. Norman A. Chapin on LinkedIn ▶ PEMBA On Demand YouTube https://www.youtube.com/@PEMBAON-DEMAND AdventHealth Apopka https://www.adventhealth.com/hospital/adventhealth-apopka Physician Executive MBA Program – University of Tennessee https://haslamgradprograms.utk.edu/programs/mba/physician-executive-pemba/

How does a practicing surgeon turn a simple idea into a global platform transforming how surgeons connect, learn, and lead? In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin interviews Dr. Mark Soliman, surgeon, entrepreneur, and graduate of the University of Tennessee Physician Executive MBA (PEMBA) program. Dr. Soliman shares his inspiring journey from clinical surgery to co-founding Surgeon, a secure social networking and education platform built exclusively for surgeons. He discusses the rapid growth of the platform, how it’s transforming peer-to-peer collaboration in surgical practice, and the realities of leading a healthcare startup. Dr. Soliman also reflects on how business education reshaped his leadership mindset, empowered his entrepreneurial goals, and provided the tools to innovate in an evolving healthcare ecosystem. His story offers valuable lessons for physicians seeking to combine clinical expertise with business acumen to create lasting impact.  Key Topics Covered The founding story and mission behind Surgeon, a secure networking and education hub for surgeons Challenges and rewards of transitioning from clinical practice to entrepreneurship Navigating early-stage startup challenges, funding, and strategic growth Building community and engagement through a physician-led digital platform The role of trust, collaboration, and security in medical networking How the PEMBA program provided business, leadership, and strategic skills for success Lessons in innovation, risk-taking, and perseverance from the startup journey Balancing the dual identities of clinician and entrepreneur Practical advice for physicians seeking to innovate or launch their own ventures The future of healthcare technology and physician-led digital ecosystems Dr. Mark Soliman's Bio: Dr. Mark Soliman, MD, MBA is a colorectal surgeon, entrepreneur, and PEMBA graduate from the University of Tennessee. He is the co-founder of Surgeon, a secure, physician-only platform designed to connect surgeons globally for education, case collaboration, and professional development. With a deep passion for innovation and leadership, Dr. Soliman combines his surgical expertise with business insight to advance healthcare through technology and community-driven solutions. Links & Resources Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple SurgeOn – Surgery Unified Platform SurgeOn App Dr. Mark Soliman on LinkedIn AdventHealth

What does it take for a physician to redefine success and build a career that truly aligns with purpose, passion, and leadership? In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin sits down with Dr. Pamela Sullivan, founder of National Healthcare Solutions, PLLC and former Chief Clinical Officer at Landmark Health. Dr. Sullivan—an accomplished physician leader, author, and consultant—shares her remarkable journey from physical therapy to emergency medicine, executive leadership, and entrepreneurship. She discusses the inspiration behind her new book, Career Prescription Guide: A Physician’s Guide for Career Transformation or Advancement, and the deeper motivations physicians should explore before making major career moves. Together, they unpack key themes from her book, including identifying your “why,” recognizing the arrival fallacy, navigating cultural fit, and building a fulfilling leadership path aligned with your values. Dr. Sullivan also reflects on her PEMBA experience, lessons from consulting, and how her MBA boosted her confidence, perspective, and leadership impact.  Key Topics Covered: The inspiration and process behind writing Career Prescription Guide How imposter syndrome and personal stories shaped the book’s message Recognizing the arrival fallacy—why new roles don’t always equal happiness Evaluating career pivots and transitions objectively, not emotionally Assessing organizational culture and finding the right professional fit The founding of National Healthcare Solutions, PLLC and lessons from consulting Balancing entrepreneurship with full-time leadership opportunities How the PEMBA experience transformed her confidence, mindset, and peer network The importance of mentorship, self-awareness, and resilience in career growth Advice for physicians seeking leadership roles or pursuing new credentials (MBA, CPE, FACHE)  Dr. Pamela Sullivan’s Bio: Dr. Pamela Sullivan, MD, MBA, CPE, FACP, FCUCM, PT is the Founder and Principal Consultant at National Healthcare Solutions, PLLC, and the former Chief Clinical Officer at Landmark Health. A board-certified physician and accomplished healthcare executive, she has led transformative initiatives in value-based care, clinical operations, and physician leadership. Dr. Sullivan is also the author of Career Prescription Guide: A Physician’s Guide for Career Transformation or Advancement, published by the American Association for Physician Leadership (AAPL). Through her work, she empowers physicians to lead with clarity, confidence, and purpose. Links & Resources Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Dr. Pamela Sullivan on LinkedIn American Association for Physician Leadership PEMBA On Demand on YouTube

How do you lead a hospital through massive transformation while still caring for patients at the bedside? In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin sits down with Dr. Karin Hotchkiss, pediatric surgeon and Chief Medical Officer at Saint Joseph’s Children’s Hospital. Dr. Hotchkiss shares her experience leading the hospital’s transformation into a freestanding children’s facility, offering an inside look at the challenges and opportunities that come with guiding large-scale organizational change. She discusses balancing clinical and administrative responsibilities, leveraging her PEMBA education to enhance leadership effectiveness, and using innovation to improve care delivery. The conversation also touches on integrating telehealth, addressing pediatric specialist shortages, and creating centers of excellence to elevate specialized pediatric care. Key Topics Covered Leading the transition of Saint Joseph’s Children’s Hospital to a freestanding facility The evolving role of the Chief Medical Officer (CMO) in modern healthcare leadership Balancing clinical practice with administrative duties while maintaining physician credibility How the PEMBA program shaped Dr. Hotchkiss’s leadership approach and decision-making Managing human resources and organizational behavior in complex healthcare systems Integrating technology and AI into strategic hospital planning and future operations Expanding telehealth and virtual care models to improve accessibility and outcomes Developing centers of excellence for high-quality pediatric specialty care Redefining medical staff structure and credentialing to support institutional growth The importance of networking, mentorship, and collaboration for physician leaders Dr. Karin Hotchkiss’s Bio: Dr. Karin Hotchkiss is a pediatric surgeon and Chief Medical Officer at Saint Joseph’s Children’s Hospital, where she oversees the hospital’s clinical operations and strategic transformation. A graduate of the Physician Executive MBA (PEMBA) program at the University of Tennessee, Dr. Hotchkiss blends her clinical expertise with business acumen to drive organizational innovation, strengthen physician engagement, and enhance pediatric care delivery. Links & Resources Dr. Norman A. Chapin on LinkedIn PEMBA On...

How does a doctor go from struggling to find a job in emergency medicine to building a platform that’s transforming how clinicians navigate their careers? In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin interviews Dr. Leon Adelman, co-founder of Ivy Clinicians. Dr. Adelman shares his journey from struggling to land emergency medicine jobs to building a groundbreaking marketplace designed to bring transparency to physician and clinician job searches. He reflects on the challenges of creating the platform, the evolution of Ivy Clinicians’ business model, and the marketing strategies that helped attract users and establish trust. The conversation also explores the shift from podcasting to a newsletter format, the transition to a paid subscription model, and how industry forces like the “No Surprises Act” and private equity ownership are reshaping emergency medicine. Dr. Adelman closes by reflecting on how his MBA experience fueled his entrepreneurial journey and continues to guide his leadership in healthcare innovation. Show Highlights: The founding story of Ivy Clinicians and its mission to create transparency in job searches Challenges of building and scaling a marketplace platform in healthcare Evolution of Ivy Clinicians’ business model and user acquisition strategies Marketing approaches that helped the company grow and gain credibility Transitioning from a podcast to a newsletter to provide deeper industry insights Navigating the move to a paid subscription model How the “No Surprises Act” is impacting emergency medicine providers The financial struggles of private equity-owned emergency medicine firms Broader implications of private equity’s role in healthcare Reflections on how an MBA experience shaped Dr. Adelman’s entrepreneurial path Dr. Leon Adelman's Bio: Dr. Leon Adelman is the co-founder of Ivy Clinicians, a healthcare marketplace focused on transparency and accessibility for job-seeking physicians and clinicians. With a background in e...

How do you transform a concierge-style medical practice into a team-based model that truly serves aging patients with chronic conditions? In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin interviews Sandy Valino Stock, Managing Medical Director at OSF Complete Care 55 Plus. Sandy shares her journey from running a concierge-style direct primary care practice to leading a team-based, insurance-inclusive model that focuses on adults 55 and older living with chronic conditions. She offers insights on adapting care models to patient needs, implementing innovative programs, and balancing leadership with clinical work. The discussion also explores physician well-being, the value of mentorship, and strategies for building sustainable, patient-centered healthcare systems. Show Highlights: Transitioning from a concierge-style direct primary care model to an insurance-inclusive system How to adapt healthcare practices to evolving patient needs and market demands Designing a unique care model for patients aged 55+ with chronic conditions at OSF Complete Care 55 Plus The impact of team-based care and cross-training staff on patient experience and efficiency Leveraging remote patient monitoring (RPM) programs for chronic condition management Addressing physician burnout and the role of self-care and mindfulness in practice Why mentorship and business acumen are essential for career transitions in medicine Growth and expansion plans for OSF Complete Care 55 Plus to serve an aging population Integrating telemedicine with personalized care strategies in modern healthcare Balancing clinical responsibilities with administrative leadership in physician roles Links and Resources: Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Sandy Valino Stock, DO, MBA on LinkedIn

In this episode of “PEMBA On Demand,” host Dr. Norman A. Chapin sits down with Dr. Thom Lobe—pediatric surgeon, entrepreneur, innovator, and founder of the T.E. Lobe Family Foundation—to explore how a family foundation can become a powerful engine for physician-led innovation. Dr. Lobe explains the trust-and-foundation structure that directs non-W2 income into mission-driven initiatives, why he chose a private family foundation, and the safeguards that ensure accountability. The conversation also highlights his three central missions: advancing early childhood education, expanding access to stem cell therapies for children, and developing an AI-enabled infant health monitoring device. Whether you’re considering your legacy, launching new ventures, or seeking sustainable ways to fund transformative care models, this episode offers both practical strategies and inspiring lessons. Show Highlights: Why Dr. Lobe created a family foundation and how it differs from a public foundation or donor-advised fund The business trust → family trust → foundation flow for non-W2 revenue (and why trusts must be irrevocable) Governance basics: directors, annual filings, spending rules (the 5% minimum distribution), and audit trails Mission focus: early childhood education, need-based support for stem cell treatments, and an AI-driven infant monitor Inside the R&D model: funding engineers, building a prototype, planning FDA studies, and aiming for affordability & access Clinical lens on stem cells for neuroinflammation in autism and other conditions; importance of repeated treatments Practical lessons learned: choosing the right attorneys/accountants, state nuances, and avoiding common setup mistakes Vision & scale: multi-million-dollar grant goals, market outlook for infant monitoring, and building a legacy vehicle for family involvement Links and Resources: Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple T.E. Lobe Family Foundation: lobefoundation.org

In this episode of "PEMBA On Demand," Dr. Joseph Nounou, a 2020 PEMBA graduate, shares his transition from anesthesia to founding Auros Pharma, a biotech startup tackling the opioid crisis with a novel medication. He discusses his motivations for pursuing an MBA, the challenges of launching a pharmaceutical company during COVID-19, and the personal and financial sacrifices involved. Dr. Nounou emphasizes the importance of physician leadership in drug development and his commitment to affordable, life-saving treatments, highlighting how business education empowered him to drive innovation and broader impact in healthcare. Show Highlights: Transition from clinical practice in anesthesia to entrepreneurship in biotech. Founding of Auros Pharma to address the opioid crisis with a novel medication. Motivations for pursuing an MBA to gain business knowledge. Challenges faced during the COVID-19 pandemic and their impact on business management. Personal transformation driven by burnout and a desire for a more fulfilling career. The process of bootstrapping a pharmaceutical startup and financial realities involved. Importance of physician involvement in the pharmaceutical industry and drug development. Regulatory complexities and the FDA approval process for new medications. The role of physicians in promoting effective and cost-efficient prescribing practices. Future aspirations for Auros Pharma's medication and the impact of mentorship from the PEMBA program. Links and Resources: Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Dr. Joseph Nounou on LinkedIn

In this episode of "PEMBA On Demand," host Dr. Norman A. Chapin interviews Dr. Amanda Ryan, an interventional cardiologist and PEMBA alum, about her mission to transform rural healthcare in New Mexico. Inspired by her grandfather’s struggles, Dr. Ryan discusses founding an independent cardiology practice and nonprofit, building local healthcare pipelines, and leveraging business skills from her MBA. She shares insights on leadership, advocacy, and using media to educate patients. Dr. Ryan also reflects on overcoming professional challenges and outlines her future goals, including law school and writing a memoir to inspire others. Show Highlights: Dr. Amanda Ryan's journey in transforming rural healthcare in New Mexico. The personal inspiration behind her career choice, influenced by her grandfather's heart condition. Challenges faced in establishing an independent cardiology practice in a rural setting. The importance of building professional relationships with other healthcare specialists. Initiatives to create a local pipeline of healthcare professionals through education and training. The founding and goals of the nonprofit organization Partners in Heart Health. Strategies for effective fundraising and community engagement to support healthcare initiatives. The role of her podcast, Homegrown Heart, in patient education and outreach. Insights on the impact of the Physician Executive MBA (PEMBA) on her career and business acumen. Future aspirations, including attending law school and writing a book to inspire others. Links and Resources: Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Dr. Amanda Ryan on LinkedIn

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin interviews Martie Ross, Consulting Principal at PYA and Director of the Center for Rural Health Advancement. Together, they explore the evolution and challenges of alternative payment models (APMs) in healthcare, focusing on rural settings, value-based care, and the need for payer alignment. Martie shares insights on adapting APMs for rural providers, the importance of clinical transformation, and the future of mandatory payment models. The episode concludes with practical resources for healthcare professionals navigating payment reform and emphasizes the ongoing need for collaboration and innovation in healthcare delivery. Show Highlights: Evolution of alternative payment models (APMs) in healthcare Impact of APMs on rural and safety-net providers Challenges and opportunities in implementing APMs in rural healthcare settings The role of the Affordable Care Act (ACA) in transforming healthcare payment structures Differences between primary care and specialty care in APM development Importance of collaboration among healthcare providers for effective patient care The significance of accurate data and benchmarks in evaluating APM effectiveness Barriers to commercial payer engagement in APMs Future directions for APMs, including mandatory episodic payment models Strategies for physician executives to navigate the transition to value-based care Links and Resources: Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Martie Ross on LinkedIn

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin interviews Angie Caldwell, CPA and MBA, a leading expert in physician compensation design. Together, they explore the complexities of fair market value, the impact of technology and AI on physician work, and the challenges of creating sustainable, effective compensation models. Angie shares insights on pitfalls in plan design, the importance of stakeholder engagement, and adapting to evolving healthcare trends. The discussion emphasizes the need for thoughtful, transparent compensation strategies that align with both organizational goals and physician well-being. Show Highlights: Physician compensation strategies and their complexities Fair market value (FMV) in compensation design Financial sustainability challenges in healthcare organizations Supply and demand issues for physicians in the healthcare market Impact of technology and artificial intelligence (AI) on physician work and compensation Common pitfalls in compensation plan design Importance of regulatory compliance in compensation models Trends in value-based care and upcoming payment model changes The role of advanced practice providers (APPs) in compensation considerations The significance of stakeholder engagement in designing effective compensation plans Links and Resources: Angie Caldwell on LinkedIn Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple Washington Updates – June 13, 2025 (PYA)

In this episode of PEMBA On Demand, host Dr. Norman A. Chapin speaks with Dr. Robert Flora, Chief Academic Officer at McLaren Health Care and Professor of Obstetrics & Gynecology at Michigan State University College of Human Medicine. Together, they explore why traditional quality improvement (QI) strategies often fall short—and what it will take to lead meaningful change in modern healthcare. Dr. Flora highlights the historical and systemic roots of today’s QI limitations, explains how rigid approaches fail to reflect the complexity of patient care, and introduces innovative frameworks like his “Nested Rapid Cycle Logic Model.” This episode empowers physician leaders with tools and insights for driving real, measurable change. Show Highlights: Why standard QI approaches are no longer sufficient Moving from binary to systems-level thinking in clinical training Integrating social and structural determinants of health into care models Embracing data-driven, team-based strategies in leadership The role of QI training in preparing the next generation of physician leaders Recognizing external influences on healthcare quality and patient outcomes Long-term outcomes vs. short-term metrics: what really matters A hopeful vision for the future of quality improvement in healthcare Links and Resources: Dr. Robert Flora on LinkedIn Dr. Norman A. Chapin on LinkedIn PEMBA On Demand Podcast on Apple

In this episode of "PEMBA On Demand," host Dr. Norman A. Chapin interviews Dr. A. Lee Hunter, Jr., a board-certified orthopedic surgeon and entrepreneur. Dr. Hunter shares his journey from clinician to founder of Hunter Med LLC, where he developed the innovative Elbow Lock device to improve elbow positioning during surgeries. He discusses the challenges of navigating FDA regulations and the importance of simplicity in medical device design. Dr. Hunter also reflects on how his MBA from the University of Tennessee has enhanced his business acumen. The episode offers valuable insights into the intersection of medicine and entrepreneurship. Show Highlights:   Transition from clinical practice to entrepreneurship in healthcare Development of the Elbow Lock device for improved surgical positioning Challenges faced in bringing a medical device to market, including FDA navigation Importance of simplicity in medical device design Insights into the regulatory landscape and patenting process for medical devices The role of an MBA in enhancing business acumen for healthcare professionals Experiences with marketing and distribution in the medical device industry Innovations aimed at improving patient care and surgical efficiency Reflections on the entrepreneurial journey and the importance of adaptability The intersection of medicine and entrepreneurship, highlighting physician leadership in healthcare innovation Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. A. Lee Hunter, Jr. on LinkedIn

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin interviews Dr. Lloyd Marks, a physician, engineer, entrepreneur, and alumnus of the University of Tennessee's Physician Executive MBA program. Dr. Marks discusses his transition from engineering to medicine, his motivation for obtaining an MBA, and his work in medical innovation. He highlights his development of a non-invasive device for detecting shock in patients and shares insights into the challenges of merging engineering with clinical practice. The conversation emphasizes the importance of interdisciplinary collaboration and the need for physician-driven innovation in healthcare. Show Highlights:   Transition from engineering to medicine and the motivations behind it Pursuit of an MBA to enhance business acumen in healthcare Development of a non-invasive device for detecting shock in patients Challenges faced in bridging engineering and clinical practice Importance of interdisciplinary collaboration in medical innovation Role of mentorship and guidance for aspiring medical entrepreneurs Significance of intellectual property protection for innovators Insights on the evolving landscape of healthcare technology Emphasis on patient-centered care in medical advancements Building professional networks and relationships in the healthcare field Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Lloyd Marks  on LinkedIn

In this episode of "Pemba on Demand," host Dr. Norman A. Chapin engages in a conversation about professional development for physicians with Dr. Archie Bella, an internist and CEO of a federally qualified health center (FQHC) in San Diego. Dr. Bella recounts his journey from being a staff physician to becoming a CEO, shedding light on the unique challenges of managing an FQHC that serves underserved populations. He shares strategies for boosting patient volume, enhancing operational efficiency, and ensuring financial stability. Dr. Bella also underscores the significance of quality improvement, community engagement, and effective communication in improving patient care and ensuring organizational sustainability. The episode offers valuable insights into healthcare leadership and management. Show Highlights:   Transition from clinical practice to healthcare leadership Role and significance of federally qualified health centers (FQHCs) Challenges faced by FQHCs in the healthcare landscape Reimbursement models for FQHCs versus private practices Strategies for increasing patient volume and operational efficiency Importance of community engagement and communication Implementation of technology to reduce patient no-show rates Development of quality improvement teams and training Financial management and strategic planning in healthcare organizations Future sustainability and adaptation of FQHCs in changing healthcare environments Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Archie Bella on LinkedIn

In this episode of "Pemba on Demand," host Dr. Norman A. Chapin engages in a conversation with Zack Buck, JD, who serves as the Associate Dean for Faculty Development and Professor of Law at the University of Tennessee, Knoxville. They delve into the topic of Chevron deference, a legal doctrine that permits agencies to interpret ambiguous laws, and examine its influence on healthcare regulation. Zack provides insights into the intricacies of healthcare law, discussing the balance between state and federal powers, as well as the potential implications of recent Supreme Court decisions that might restrict agency authority. The discussion underscores the significance of comprehending legal frameworks for effective healthcare leadership and the navigation of regulatory changes. Show Highlights:   Chevron deference and its implications for healthcare regulation The role of administrative law in healthcare practices Health policy matrices: access, cost, quality, and choice The impact of recent Supreme Court decisions on agency authority The balance of power between state and federal governments in healthcare regulation Challenges faced by healthcare leaders in navigating legal frameworks The transition from fee-for-service to value-based care models Potential monopolistic practices resulting from regulatory interventions The relationship between regulatory compliance and ethical responsibilities in healthcare The importance of staying informed about legal developments in healthcare law Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Zack Buck on LinkedIn

In this episode of "Pemba on Demand," host Dr. Norman A. Chapin welcomes Dr. Christopher Chisholm, Chief Medical Officer for Swedish Health Systems in Seattle, Washington. Dr. Chisholm, a recent Pemba program graduate, shares insights from his 20-year naval medicine career and his transition to civilian healthcare leadership. Titled "From Kandahar to COVID: Leadership Lessons from the Past Quarter Century," the episode explores differences between military and civilian healthcare, team-building challenges, and the COVID-19 pandemic's impact on leadership. Dr. Chisholm emphasizes the importance of communication, adaptability, and simulation training in effective healthcare leadership. Show Highlights:  Transition from military to civilian healthcare leadership Leadership lessons from military medicine Differences between military and civilian healthcare systems Challenges of team building in high-pressure environments Impact of the COVID-19 pandemic on healthcare leadership Importance of communication and collaboration in teams Managing stress and burnout among healthcare professionals Simulation training for high-stakes healthcare situations Insights from the Pemba program on healthcare administration Advice for emerging physician leaders on collaboration and growth Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Christopher Chisholm on LinkedIn

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin and guest Dr. Donald Lighter, MD discuss the critical role of physician leadership in healthcare. Dr. Lighter, a core faculty member of the Pemba program with a background in pediatrics, shares insights on the evolution of physician roles, the importance of developing soft skills, and the relevance of the Baldrige framework. They highlight the Pemba program's impact on fostering leadership skills, the significance of value-based care, and the necessity of continuous improvement in healthcare. Dr. Lighter also recounts memorable teaching moments and emphasizes the importance of networking and collaboration among physicians.. Show Highlights:  Evolution of the Pemba program and its impact on physician leadership. Importance of physician leadership in enhancing healthcare systems. Development of soft skills in physicians for effective leadership. Overview of the Baldrige framework and its relevance to healthcare quality improvement. Achievements and contributions of Pemba alumni in various healthcare sectors. Challenges faced by physician leaders in maintaining patient-centered care. Shift towards value-based care and its implications for healthcare delivery. Role of teamwork and collaboration in healthcare settings. Importance of patient engagement and satisfaction in healthcare outcomes. Future trends and challenges in physician leadership within evolving healthcare landscapes. Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Donald Lighter on LinkedIn Books on Quality Improvement in Healthcare: Basics of Health Care Performance Improvement: A Lean Six Sigma Approach (1st Edition) – Barnes & Noble Advanced Performance Improvement in Health Care: Principles and Methods – Barnes & Noble Essentials for Quality and Safety Improvement in Health Care: A Resource for Developing Countries – Barnes & Noble Curing Health Care: New Strategies for Quality Improvement (1st Edition) – Barnes & Noble

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin converses with Dr. Sandy Villano Stock about her entrepreneurial journey in concierge medicine and direct primary care. Dr. Villano Stock discusses how her MBA from Pemba influenced her decision to establish In Vogue Med and Wellness, focusing on personalized patient care. The episode addresses the challenges in healthcare, such as physician burnout and the shortage of primary care doctors, and highlights the benefits of innovative care models. Dr. Villano Stock shares insights on balancing business models, measuring patient satisfaction, and the importance of work-life balance for healthcare providers. Show Highlights: The journey of Dr. Sandy Villano Stock in entrepreneurship within concierge medicine and direct primary care. The impact of an MBA on career development and practice establishment. Challenges in the healthcare industry, including physician shortages and burnout. The rising demand for personalized healthcare post-COVID-19. The growth of concierge medicine and direct primary care models. Innovative patient care strategies, including smaller patient panels and direct communication with physicians. Membership models in healthcare, contrasting concierge care with traditional insurance billing. The importance of measuring patient experience and retention in medical practices. Integration of telehealth services and after-hours care in patient management. Advice for physicians considering a transition to concierge medicine or direct primary care. Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Bruce Meyer on LinkedIn

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin revisits a conversation with Dr. Bruce Meyer, Executive Vice President for Highmark Health, focusing on value-based care and healthcare transformation. Dr. Meyer shares insights from his journey, including his MBA from the University of Tennessee, and addresses systemic challenges in U.S. healthcare, such as high administrative costs and inefficiencies. He stresses the importance of transitioning from fee-for-service to value-based care, underscoring the role of non-physician providers and the necessity of structured healthcare budgeting. The episode also highlights mentorship, particularly Dr. Meyer's impact on Dr. Jason Gunderson's career. Show Highlights: Value-based care and its importance in healthcare transformation. The systemic challenges and inefficiencies in the U.S. healthcare system. The impact of healthcare costs on personal bankruptcy and financial sustainability. The role of government payers like Medicare and Medicaid in healthcare funding. The historical escalation of healthcare spending in the U.S. and its implications. The transition from a fee-for-service model to a value-based care approach. The significance of mentorship in professional development within healthcare. The cultural differences in healthcare delivery between the U.S. and other countries. The potential of non-physician providers in enhancing patient care and system efficiency. The need for collaboration between payers and providers to improve patient outcomes and manage costs effectively. Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Dr. Bruce Meyer on LinkedIn

In episode 31 of "Pemba on Demand," host Dr. Norman A. Chapin revisits the podcast's inaugural live stream with guest Dr. Rinku Mehra, a pediatric endocrinologist and founder of a direct specialty care practice. Dr. Mehra shares her journey from a corporate job to establishing her own practice after obtaining an MBA. She discusses challenges in traditional healthcare, such as limited access to specialists and patient dissatisfaction. Embracing telemedicine and a concierge model, Dr. Mehra emphasizes personalized care and patient education. The episode highlights her innovative approach to healthcare and future plans for expanding her practice. Show Highlights: Dr. Rinku Mehra's background and training in pediatric endocrinology. Transition from a corporate job to founding an independent direct specialty care practice. Challenges faced in traditional healthcare delivery, including access and patient dissatisfaction. Adoption and benefits of telemedicine in improving patient engagement and satisfaction. Implementation of a direct care model that emphasizes transparency and personalized care. Focus on patient-centric approaches, including extended appointment times for better understanding of patient needs. Plans for expanding telemedicine services and incorporating additional physicians into her practice. Use of social media for patient education and combating misinformation in healthcare. Creation of educational resources for parents regarding nutrition and health conditions. Reflections on pursuing an MBA and its impact on her career and practice model. Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Norman A. Chapin on LinkedIn Rinku Mehra on LinkedIn

In this episode of "Pemba On Demand," titled "The Physician's Guide to Leadership Careers: Insights from Top Recruiters," host Dr. Norman A. Chapin welcomes Katherine Nichols, Executive Recruiter for HCA Healthcare, and Mark Dotson, Director of Physician Executive Recruiting at Jackson Physician Search. They discuss the essential aspects of preparing for leadership roles in healthcare. Key topics include the importance of persistence in communication, thorough research before interviews, structured onboarding processes, and the significance of emotional intelligence and relationship-building skills. The episode offers valuable advice for physicians transitioning into leadership roles, emphasizing preparation, presentation, and personal branding. Show Highlights: Insights into the role of physician leaders in healthcare organizations. The current demand for qualified physician leaders and market trends. The evolving responsibilities of Chief Medical Officers (CMOs) and Associate CMOs. The impact of artificial intelligence (AI) on healthcare leadership and recruitment. Essential skills and qualities for physicians transitioning into leadership roles. The importance of emotional intelligence and relationship-building in leadership. The value of obtaining an Executive MBA (EMBA) for aspiring physician leaders. Strategies for effective interview preparation and resume presentation. The significance of thorough research on organizations before interviews. Best practices for onboarding new executives in healthcare settings. Links and Resources: Physician Executive MBA at the University of Tennessee Mark Dotson Katherine Nichols

In this episode of "Pemba on Demand: Leadership Odyssey Bridging Medicine and Business," host Dr. Norman A. Chapin interviews Dr. Michael Marks, Senior Medical Director for Relievant Medsystems, Inc. Dr. Marks shares his journey from being an orthopedic spine surgeon to taking on a leadership role in the medical device industry. He discusses his experiences in the Physician Executive MBA program at the University of Tennessee, his leadership in merging orthopedic groups, and his transition into hospital administration. The episode highlights Dr. Marks' career path, emphasizing the significance of education, mentorship, and collaboration in navigating healthcare management and physician leadership. Show Highlights: Transition from clinical practice to leadership roles in healthcare. Significance of the Physician Executive MBA (PEMBA) program for physicians. Challenges and strategies in healthcare mergers and cultural integration. Importance of empathy and communication in patient care. Role of mentorship in professional development and career growth. Navigating personal health challenges while maintaining a connection to clinical practice. Advocacy for patient care and addressing insurance coverage issues. Impact of healthcare expenditures on Medicare and Medicaid. Continuous learning and adaptability in the evolving healthcare landscape. The importance of collaboration and shared goals in leadership. Links and Resources: Physician Executive MBA at the University of Tennessee Michael Marks MD MBA

In this episode of the "Pemba On Demand", host Dr. Norman A. Chapin introduces the session and guest, Jasen Gunderson, CEO of CardioOne and a 2007 alumnus of the University of Tennessee's Physician Executive MBA program. The discussion centers on "Redefining Independence: Unlocking the Value of Physician Practices," focusing on the challenges and opportunities for independent cardiologists. Jasen shares his journey from family medicine to leading a private equity-backed company, emphasizing the importance of strategic thinking, networking, and leadership development. The episode concludes with audience engagement and a call to action for continuing medical education credits. Show Highlights: Overview of the "Pemba On Demand" live stream series and its educational purpose for physician leaders. Discussion on the evolving landscape of physician practices, particularly in cardiology. Challenges and opportunities for independent cardiologists in the current healthcare environment. The significance of value-based care versus fee-for-service models in cardiology. Importance of revenue growth and financial management for independent practices. Strategies for maintaining independence among cardiologists and transitioning practices. The role of technology and innovative solutions in enhancing operational efficiency. Insights on leadership development and team building within healthcare organizations. The impact of networking on career advancement for physicians. Links and Resources: Email: jasen@cardioone.com LinkedIn: Jasen Gundersen, MD, MBA Organization: American Independent Medical Practice Association Medicare Cost and Utilization Across Physician Affiliation Models Physician Executive MBA at the University of Tennessee

In this episode of the "Pemba On Demand" podcast, host Dr. Norman A. Chapin interviews Dr. James Calvin, a cardiologist and physician executive, about his efforts in establishing a Center for Quality, Safety, and Innovation at Western University. Dr. Calvin discusses the challenges and strategies involved in creating a structured approach to improve patient care. He emphasizes the importance of collaboration, leadership, and data-driven decision-making in fostering a culture of quality improvement. The episode also highlights the significance of engaging various departments and securing support to drive impactful healthcare initiatives. Show Highlights: Establishment of a Center for Quality, Safety, and Innovation in an academic medical setting. Challenges faced in creating a structured approach to quality improvement. Importance of collaboration and support from various departments in healthcare. Strategies for securing funding and resources for quality improvement initiatives. Role of leadership in driving change and fostering a culture of quality. Use of data and evidence to demonstrate the need for quality improvement. Development of innovative projects, including virtual clinics and smartphone applications for patient management. Engagement of faculty and students in quality improvement efforts across multiple departments. Importance of data storytelling and performance indicators in driving healthcare improvements. Reflection on the transformative impact of leadership training and education in navigating healthcare challenges. Links and Resources: Physician Executive MBA at the University of Tennessee James Calvin

In this episode of the "Pemba On Demand" podcast, host Dr. Norman A. Chapin celebrates the one-year anniversary by interviewing Dr. Francois Nader, an alumnus of the Physician Executive MBA program at the University of Tennessee. Dr. Nader shares his journey from medicine to the biotech industry, emphasizing the evolving role of physicians in life sciences. He discusses opportunities for physicians in biotech, the appeal of continuous learning, and the complexities of drug development and pricing. The episode provides valuable insights for physicians considering a transition into the biotech sector, highlighting the industry's dynamic nature and potential for innovation. Show Highlights: Transition of physicians from clinical practice to the biotech industry. Opportunities for physicians in biotech and life sciences. Evolving roles of physicians in drug development and patient care. Insights into the drug development process and its complexities. Discussion on drug pricing and its implications for healthcare. Importance of continuous learning and adaptation in the biotech sector. Skills and specialties in demand within the biotech industry. The impact of the COVID-19 pandemic on biotech innovation and awareness. Value of an MBA for physicians transitioning to industry roles. Challenges faced by physicians when moving from clinical to industry environments. Links and Resources: Physician Executive MBA at the University of Tennessee Francois Nader, MD, MBA

In this episode of "Pemba On Demand," hosted by Dr. Norman A. Chapin, Dr. Jay Grider, an anesthesiologist and Chief Quality Officer at UK Healthcare, shares his journey in physician leadership. Dr. Grider discusses the transformation of UK Healthcare, emphasizing the importance of understanding both clinical and administrative perspectives. He highlights the impact of the Affordable Care Act and Medicaid expansion on healthcare access in Kentucky. Dr. Grider also addresses challenges in managing opioid prescriptions and offers advice to young physicians aspiring to leadership roles. The episode concludes with reflections on creating a supportive healthcare environment and the significance of continuous improvement. Show Highlights: Insights on physician leadership and its significance in healthcare management. Transformation of UK Healthcare and its growth as a major healthcare provider. The impact of the Affordable Care Act and Medicaid expansion on healthcare access in Kentucky. Addressing social determinants of health and adapting to chronic diseases and an aging population. Challenges in managing opioid prescriptions and initiatives to reduce dependency. The importance of effective communication between clinical and administrative leaders. The role of personal motivation and values in pursuing leadership positions in healthcare. The dynamics of organizational culture and the transient nature of healthcare leadership roles. The significance of professional development and obtaining credentials like an MBA for healthcare leaders. Strategies for ensuring vulnerable patients receive adequate care and addressing health disparities. Links and Resources: Physician Executive MBA at the University of Tennessee Jay S Grider DO, PhD, MBA

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin converses with Dr. Hank Schiffers, an experienced healthcare consultant. The discussion focuses on healthcare entrepreneurship, particularly how physician entrepreneurs can monetize medical innovations. Dr. Schiffers shares his journey, comparing the complexities of launching products in the US and EU markets, and offers advice on navigating regulatory landscapes. He emphasizes the importance of understanding market dynamics, leveraging AI in healthcare, and effective communication within organizations. The episode concludes with reflections on the value of the Physician Executive MBA program and encourages listener engagement. Show Highlights: Entrepreneurship in the healthcare sector Monetization of medical innovations by physician entrepreneurs Differences between launching products in the US and EU markets Regulatory landscape for life science startups The impact of artificial intelligence (AI) on healthcare innovation Overcoming resistance to innovation in larger healthcare organizations Effective communication strategies for physician entrepreneurs Insights from the Physician Executive MBA (PEMBA) program Current trends in life science innovation and regulatory changes Importance of understanding reimbursement processes in healthcare markets Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Hank Schiffers https://www.linkedin.com/in/hankschiffers/?originalSubdomain=de

In this episode of "Pemba On Demand," host Dr. Norman A. Chapin and guest Dr. Harvey Castro discuss the transformative role of artificial intelligence (AI) in healthcare. Dr. Norman A. Chapin introduces the episode by highlighting the Physician Executive MBA program and the focus on AI's impact on medicine. Dr. Castro, an emergency medicine physician with expertise in AI, shares his journey through the MBA program and his transition into AI. He emphasizes AI's potential to enhance both professional and personal lives for physicians, improve diagnostic accuracy, and streamline medical education. The episode underscores the importance of integrating AI thoughtfully into medical practice. Show Highlights: The transformative role of artificial intelligence (AI) in healthcare. Insights from an emergency medicine physician with expertise in AI. The impact of AI on enhancing medical practices and personal efficiency. Experiences from the Physician Executive MBA program and its relevance to AI. The potential of AI to improve diagnostic accuracy and patient care. The importance of integrating AI tools into everyday medical practice. The balance between clinical judgment and AI-generated insights. The implications of AI in medical education and training. Concerns regarding the reliability and ethical use of AI in healthcare. The future of AI in personal lives and its integration into daily activities. Links and Resources: Physician Executive MBA at the University of Tennessee Dr. Harvey Castro https://www.linkedin.com/in/harveycastromd/

In this episode of the "Pemba On Demand" podcast, host Dr. Norman A. Chapin interviews Dr. Julianna Reece, Director of the Healthy Tribes program at the CDC's National Center for Chronic Disease Prevention. Dr. Reece shares her journey as a Navajo woman in public health and medicine, discussing her challenges with anatomy education and her commitment to integrating traditional healing with Western medicine. She emphasizes the importance of culturally relevant healthcare approaches and community-based initiatives to address health disparities in Indigenous and Native American communities. The episode highlights her leadership in healthcare innovation and her efforts to improve health outcomes for tribal populations. Show Highlights: Overview of the Physician Executive MBA program at the University of Tennessee. Dr. Juliana Reece's personal and professional journey in public health and medicine. Cultural significance of introductions in Navajo tradition and its impact on identity. Challenges faced in medical education, particularly in anatomy and cadaver work. Integration of traditional healing practices with Western medicine. Focus on addressing health disparities in Indigenous and Native American communities. Importance of community-based initiatives and culturally relevant healthcare approaches. Discussion on chronic disease management and the need for holistic health strategies. The role of food systems and access to healthy foods in Indigenous health. Emphasis on collaboration and partnerships to enhance healthcare delivery and support for tribal communities. Links and Resources: Physician Executive MBA at the University of Tennessee Julianna Reece, MD, MBA, MPH on LinkedIn CDC Healthy Tribes

In this episode of "Pemba On Demand," host Norman A. Chapin discusses the profound effects of the COVID-19 pandemic on medical education with Dr. James Calvin, a physician executive and professor at Western University. Titled "Rethinking Residency: Innovations in Medical Education Post-COVID" the episode explores the challenges faced by residency programs, including heightened anxiety, changes in teaching methods, and the overall impact on residents' education and well-being. Dr. Calvin highlights wellness initiatives, feedback mechanisms, and the importance of adaptability in medical training. The episode underscores the need for continuous improvement and collaboration in medical education during crises. Show Highlights: Impact of COVID-19 on medical education and residency programs in Canada. Challenges faced by residents during the pandemic, including anxiety and changes in teaching methods. Implementation of wellness initiatives to support residents' mental health. Feedback mechanisms and changes in training based on resident experiences during the pandemic. Long-term adaptations in medical education, including virtual learning and new teaching methods. Future considerations for residency training and the importance of stakeholder collaboration. Organizational responses to the pandemic, including public health integration and wellness leadership. Reflections on public health responses and preparedness for future pandemics. Career development and the value of pursuing an MBA for healthcare leadership. Balancing financial and quality outcomes in healthcare management. Links and resources: Pemba at the University of Tennessee University of Chicago AI and Data Science Certificate Balanced Scorecard Institute Tableau Official Website

In the "Revolutionising Healthcare: AI's Role in Modern Medicine" episode of "Pemba On Demand," host Dr. Norm Chapin interviews Dr. Benson Babu, a New York City internist and AI expert. They explore AI's transformative impact on healthcare, discussing its current state, regulatory challenges, and future potential. Dr. Babu highlights AI's role in improving clinical decision-making, operational efficiency, and patient outcomes. The conversation also covers AI certification, energy costs, and cybersecurity. Dr. Babu emphasises the importance of continuous professional development and physician leadership in integrating AI into healthcare. The episode underscores AI's growing significance in modern medicine. Show Highlights: The transformative impact of artificial intelligence (AI) in healthcare. Current state and advancements of AI technology across various industries. The regulatory landscape governing AI applications in healthcare. Economic implications of AI and its role as an economic engine in multiple sectors. The integration of AI in electronic medical records (EMR) and electronic health records (EHR). The importance of informatics professionals in refining AI applications in healthcare. Challenges and opportunities for physician leadership in AI implementation. The potential for AI to enhance clinical practices and improve patient outcomes. Concerns regarding cybersecurity and the dual nature of AI in protecting against cyber threats. Future trends in AI, including the development of low-code environments for easier integration in healthcare systems. Links and resources: HIMSS Pemba at the University of Tennessee Advanced Provider Practice on Amazon

In this episode of the "Pemba On Demand" podcast, host Dr. Norm Chapin discusses entrepreneurship and innovation in healthcare with three guests. Breanna Hale, Executive Director of the Anderson Center for Entrepreneurship and Innovation, highlights the center's mission and resources for aspiring entrepreneurs. Brandon Bruce, Managing Director of Techstars Industries of the Future, emphasizes the unique role of physicians in driving healthcare innovation and the supportive entrepreneurial ecosystem in Knoxville. Lewis Hibbs, co-founder of NKA Bio, shares his positive experiences collaborating with the University of Tennessee. The episode underscores the importance of collaboration, mentorship, and available resources for healthcare entrepreneurs. Show Highlights: Entrepreneurship and innovation in healthcare Role of the Anderson Center for Entrepreneurship and Innovation Support and resources for aspiring entrepreneurs Impact of Techstars on the entrepreneurial ecosystem Challenges faced by physician entrepreneurs Importance of mentorship and networking in entrepreneurship Collaboration between universities and startups Strategies for validating business ideas through low-cost experiments Opportunities for students to gain experience in startups   Links and Resources: Techstars Industries of the Future Accelerator Videos of Demo Day: https://techstars.wistia.com/folders/6v9ezgyjgm Demo Day slide decks: https://docs.google.com/presentation/d/1DPNp85y0dh_RUK5iFkXxq5gD0RJjqebu7gueSuVdbYA/edit#slide=id.g2e2bac8c82b_0_0 Introduction to the 2024 founders: https://www.teknovation.biz/participants-in-techstars-cohort-3-introduced-to-the-knoxville-community/ www.nkabio.com Breanna Hale on LInkedIn Brandon Bruce on LinkedIn Lewis Hibbs on LinkedIn

In this episode of "PEMBA On Demand," host Dr. Norm Chapin interviews Dr. Steven J. Stack, the Commissioner for Public Health and Chief Medical Officer, Commonwealth of Kentucky and an alumnus of the Physician Executive MBA program at the University of Tennessee Knoxville. Dr. Stack discusses his role in managing public health programs, especially during the COVID-19 pandemic, and his transition from emergency medicine to public health leadership. He highlights the importance of effective communication and navigating government processes. The episode also explores Dr. Stack's involvement with the Association of State and Territorial Health Officials (ASTHO) and the challenges physicians face in impacting public policy. Show Highlights:  Introduction of Dr. Steven J. Stack, MD, MBA, as the guest on the podcast "PEMBA On Demand" Dr. Stack's role as the Commissioner for Public Health for the Commonwealth of Kentucky Dr. Stack's background in emergency medicine and leadership roles in healthcare Insights into Dr. Stack's responsibilities and challenges as the Commissioner for Public Health Dr. Stack's transition from advocating for physicians to being in a government role Dr. Stack's involvement in the Association of State and Territorial Health Officials (ASTHO) and its role in shaping the response to COVID-19 Challenges physicians face in impacting public policy and the evolving healthcare landscape Dr. Stack's reflections on the impact of corporatization and private equity in healthcare Importance of mentorship and leadership development in Dr. Stack's career progression The multifaceted nature of Dr. Stack's role and the complexities of public health policy and advocacy Links and Resources: University of Tennessee Physician Executive MBA  https://www.linkedin.com/in/stevenstack/ https://www.fns.usda.gov/wic https://chfs.ky.gov/agencies/dph/dmch/ecdb/Pages/first-steps.aspx https://hab.hrsa.gov/about-ryan-white-hivaids-program https://www.hhs.gov/ https://www.simonandschuster.com/books/Bowling-Alone/Robert-D-Putnam/9780743203043 https://www.toastmasters.org/ https://jamanetwork.com/

In this episode of Pemba on Demand, host Dr. Norm Chapin interviews Dr. Kirk Pinto, a pediatric urologist and 2018 alumnus of the University of Tennessee PEMBA program. Dr. Pinto shares his journey from experiencing burnout in corporate medicine to focusing on physician wellness. He discusses the impact of the physician executive MBA program on his career and well-being, effective strategies for addressing burnout, and the importance of systemic approaches. Dr. Pinto also highlights the role of peer support programs and the AMA's "Joy in Medicine" program in fostering a positive work environment for physicians. Show Highlights: Dr. Pinto's background and experience with burnout in corporate medicine Impact of the physician executive MBA program on Dr. Pinto's career and well-being Factors contributing to burnout in corporate medicine Effective strategies to address physician burnout in organizations Measurement and management of burnout, including tools and concepts Systemic approach to addressing burnout in organizations AMA's "Joy in Medicine" program and its impact on addressing burnout Relationship between burnout, depression, and suicide Peer support programs in addressing burnout Links and Resources: University of Tennessee Physician Executive MBA  Cook Children's Physician Network American Urological Association Annual Meeting For more information on the Maslach Burnout Inventory Pareto Chart

In this episode of "Pemba on Demand," host Norm welcomes Dr. John Pracyk, Chief Medical Safety Officer and Global Senior Vice President for Olympus Corporation. Dr. Pracyk discusses his career transition from clinical medicine to the MedTech industry, highlighting his roles in global medical safety, medical affairs, and infection prevention. He shares insights on the importance of understanding healthcare systems, value analysis, and cost constraints. Dr. Pracyk emphasizes the necessity of leadership experience, business acumen, and adaptability for physicians transitioning to industry roles. He also reflects on the value of continuous learning, networking, and mentorship within the Pemba community.

In this podcast episode, Dr. Leon Adelman, co-founder of Ivy Clinicians, shares his journey from struggling to find emergency medicine jobs to creating a marketplace that enhances job search transparency. He discusses the challenges of building the platform, the evolution of their business model, and the marketing strategies used to attract users. Dr. Adelman also talks about the shift from a podcast to a newsletter for deeper industry insights, the transition to a paid subscription model, and the effects of the "No Surprises Act" on emergency medicine. Additionally, the financial struggles of private equity-owned emergency medicine firms and their impact on the industry are examined. The episode wraps up with Dr. Adelman reflecting on his MBA experience and its role in his entrepreneurial endeavors.   Show Highlights:   Founding of Ivy Clinicians Challenges of building a marketplace Evolution of Ivy Clinicians' business model Marketing strategies for Ivy Clinicians Success of the business and in-house staff Transition from podcast to newsletter Impact of transitioning to a paid subscription model Private equity in the healthcare industry Impact of the "No Surprises Act" on healthcare providers Financial challenges faced by emergency medicine management firms   Links and Resources:   Ivy Clinicians   Dr. Adelman’s LinkedIn Profile   Ivy Clinicians Blog   APP Staffing Firm Folds   No Surprises Act

We are delighted to have Dr. Camilo Gomez joining us today to share the details of a Lean Six Sigma project he developed for optimizing urgent stroke endovascular interventions. Dr. Gomez is a vascular and interventional neurologist who graduated from the Pemba program in 2006. He currently practices at the University of Missouri Medical Centre.  Stay tuned to learn how Dr. Gomez approached this innovative Lean Six Sigma project at the University of Missouri Medical Center. The Pemba MBA Program Dr. Gomez highly recommends the Pemba program, especially for mid-career professionals and those in managerial roles. He praises the program for its medical-focused curriculum, which applies business principles directly to healthcare settings, believing that all department chairs in universities should undergo similar training to enhance their leadership capabilities. Transition to Private Practice In 2003, Dr. Gomez left his role as Stroke Center Director at the University of Alabama, Birmingham. He then joined the business world and established a private practice group, prompting him to write a business plan and secure a loan before joining the MBA program. Realization of Business Knowledge Necessity As the CEO of his new private practice, Dr. Gomez saw the need for business knowledge to communicate, negotiate, and manage effectively. A chance meeting with an old friend solidified his decision to enroll in the MBA program. Return to Academia In 2016, Dr. Gomez returned to the academic world to focus on education, research, and high-end practice. His MBA experience helped him streamline his roles and focus on quality care and operational excellence. Influence of MBA in Academic Role Dr. Gomez found his MBA knowledge invaluable in academic settings, especially when dealing with hospital administrators.  Optimizing Endovascular Interventions Dr. Gomez is deeply involved in enhancing healthcare processes at the University of Missouri, particularly in stroke care. He actively leads initiatives that streamline operational workflows, improve patient outcomes, and integrate Lean Six Sigma methodologies for continuous process improvement. His work underscores the importance of data-driven decision-making, interdisciplinary collaboration, and innovation in healthcare delivery. Challenges and Quality Metrics Dr. Gomez finds the current quality metrics for stroke centers inadequate. He emphasizes the need for more sophisticated analysis and better metrics, drawing on principles like Lean Six Sigma to improve processes and outcomes. Breakdown of Interventions and Categories He explains the complexity of various interventions, highlighting the need to categorize them to ensure accurate performance assessment. He proposes developing and publishing a categorization grid to enhance understanding and measurement of intervention quality. Anesthesia Team Readiness Dr. Gomez explains the importance of having an anesthesia team ready to receive patients immediately. That includes starting the intubation process before other team members arrive to ensure continuous patient care without any delays. Expedited Transport Dr. Gomez emphasizes the need for quick patient transport from the CT table to the angiography table without unnecessary stops, aiming to reduce wasted time and improve efficiency in stroke treatment processes. Value Stream Mapping and Parallel Processing Dr. Gomez explains how he uses value stream mapping to identify and eliminate inefficiencies, allowing for parallel processing, where different team members perform tasks simultaneously rather than sequentially. Challenges an...

We are thrilled to welcome Nancy Scott as our guest for this episode of Pemba on Demand.  Nancy is the Leadership Development Programs Director for Graduate and Executive Education at the University of Tennessee Haslam College of Business.  She joins us today to discuss the new Chief Medical Officer (CMO) Accelerator Program now available at the University of Tennessee. Nancy's Background and Role at UT Nancy has a background in industrial and organizational psychology. That, coupled with her experiences as a graduate student, shaped her passion for training future leaders in healthcare. Structure and Content of the CMO Accelerator Program  The CMO Accelerator Program follows a structured format, including synchronous virtual sessions and personalized assignments tailored to real-world challenges in healthcare leadership. Target Audience and Program Goals  The primary target audience for the CMO Accelerator Program includes physician leaders aspiring to CMO roles and those seeking to enhance their strategic management skills in healthcare. Feedback and Improvements from Cohort One  Feedback from the first cohort of the CMO Accelerator Program has led to improvements in peer exposure, assignment clarity, and potential expansions like financial management training. Admissions and Logistics  Prospective students interested in the CMO Accelerator Program can contact Tom Brown for admissions information and application details. The program accepts a limited number of students per cohort, and seats may still be available for the upcoming cohort starting on the third Thursday of May 2024.  Future Vision and Expansion of the Program  The vision for the CMO Accelerator Program includes becoming a trusted resource in healthcare leadership development within five to ten years. Links and resources: Visit our YouTube Channel PEMBA On-Demand Norman A. Chapin, MD MBA: Norm Chapin on LinkedIn Email Norm Chapin  CMO Accelerator Program CMO Accelerator University of Tennessee is now accepting applications for the upcoming cohort beginning May 16, 2024.  Physician Executive MBA Program University of Tennessee For more information, contact Tom Brown. tjbrown@utk.edu 865.742.1596

We are delighted to welcome Dr. Ed Millermaier as our guest for this week’s episode of Pemba On Demand. Dr. Millermaier is an associate-certified coach and team practitioner coach. He established Pivot Partnerships, his coaching company, in 2020 and has actively engaged in coaching for the past three to four years. He graduated from Pemba in 2006, and we have had the privilege of collaborating with him for many years.  Dr. Millermaier joins us today to share his insights and expertise on mentorship and coaching.  Exploring Coaching in Healthcare Dr. Millermaier discusses the transformative power of coaching, emphasizing a shift away from traditional directive approaches. This shift empowers individuals, including healthcare professionals, to take charge of their growth and decision-making processes, enriching patient interactions and fostering a culture of continuous improvement and self-efficacy within clinical settings. Dr. Millermaier's insights shed light on the profound impact coaching can have on enhancing overall healthcare outcomes. Application in Clinical Settings Dr. Millermaier elaborates on leveraging coaching principles in executive coaching and strategic decision-making processes in healthcare organizations. That includes addressing unique challenges physicians face in leadership roles, particularly navigating between frontline clinical experiences and broader organizational strategies.  Challenges in Leadership Roles Dr. Millermaier outlines the challenges physicians encounter in leadership roles, especially during critical periods such as the COVID-19 pandemic. Those challenges often bridge the gap between clinical expertise and strategic decision-making. Effective communication, collaboration, and adaptive leadership become paramount in addressing those challenges and ensuring optimal healthcare delivery. Team Coaching for Empowerment Dr. Millermaier emphasizes the transformative potential of team coaching in healthcare settings. Coaching fosters empowerment and collaborative problem-solving among healthcare teams, enhancing team dynamics and patient outcomes. The success stories and methodologies Dr. Millermaier shares highlight the positive impact of team coaching, ultimately leading to improved healthcare delivery and patient care experiences. Structured Coaching Process Dr. Millermaier outlines a structured coaching process for establishing a foundation for success in coaching sessions. It includes active listening, goal setting, and ongoing feedback mechanisms to ensure alignment with client objectives and desired outcomes. By following a systematic approach, healthcare professionals can effectively utilize coaching for personal and professional development. Importance of Formal Training Dr. Millermaier highlights the essential role of ongoing training and credentialing in honing coaching skills and staying abreast of evolving healthcare and coaching landscapes. The emphasis on continuous learning and professional development contributes to maintaining high standards of coaching practice within healthcare contexts. Differentiating Coaching and Mentoring Distinguishing coaching and mentoring, Dr. Millermaier explains how each role serves unique purposes based on client needs. Coaching focuses on providing goal-oriented support, fostering accountability, and promoting personal growth. Mentorship offers guidance and expertise based on the mentor's experiences, providing valuable insights for professional development. Understanding these differences enables healthcare professionals to leverage both coaching and mentoring effectively. Envisioning the Future Dr. Millermaier envisions a future where coaching methodologies are seamlessly integrated int...

I am thrilled to introduce a fellow Pemba alumnus, Dr. Michael Fromke, as our guest for this episode of Pemba on Demand. Dr. Fromke graduated from Pemba in 2022. He is a neurosurgeon at Lee Health in Florida, an organization in which he holds a physician executive role in addition to practicing neurosurgery. He is also a member of the lead professional group at Lee Health. He joins us today to discuss the improvement project he has been working on, explaining how he applied lessons learned from his MBA program at Pemba to drive value-based care initiatives, supply chain restructuring, cost efficiencies, and standardization in healthcare delivery. Links and resources: Visit our YouTube Channel PEMBA On-Demand Click here to download the slide from this presentation   Norman A. Chapin, MD MBA: Norm Chapin on LinkedIn Email Norm Chapin    Michael Fromke, MD, MBA, FAANS Michael Fromke on LinkedIn Lee Health

On today's episode, we have Dr. Nicholas Wells and Dr. Monica Jones, physician leaders from the Erlanger health system in Chattanooga, Tennessee, joining us today.  Dr. Jones is currently the Chief Medical Officer at Erlanger East Hospital, and Dr. Wells is the Associate Medical Director of the NICU at the Children's Hospital within the Erlanger system. Dr. Wells earned his MD degree from the Uniformed Services University in 2006. Alongside his work as a neonatologist, he held the position of Chief Medical Officer for the Education Research Training Directorate at the Walter Reed National Military Medical Center for nearly two years. He is also a certified Epic Builder, responsible for the order set to build and EMR implementation in the NICU since 2021. He took on his current role as the Associate Medical Director for the NICU in 2019. Dr. Wells is currently in the Pemba MBA program of 2024.  Dr. Jones earned her MD from Indiana University School of Medicine in 1980. Following that, she underwent training in anesthesia and completed a fellowship specializing in obstetrical anesthesia. While Dr. Jones was practicing as an anesthesiologist between 1984 and 2019, she also spent six years as the assistant professor of anesthesia at Baylor College of Medicine. In 2019, she transitioned to become the Chief Medical Officer at Erlanger East Hospital in Chattanooga. Dr. Jones obtained her MBA from Pemba in 2011. Nick Wells and Monica Jones join us today to discuss a project they initiated to improve neonatal and newborn resuscitation in the early stages, focused on enhancing safety in the OR for infants born through C-section. Links and resources: Norm Chapin on LinkedIn Visit our YouTube Channel  Erlanger East Hospital The Children’s Hospital at Erlanger

We are delighted to have Dr. James Daniel Moore joining us today to discuss an innovative strategy he pioneered at the University of Kentucky to address hepatitis C, a prevalent infectious disease affecting his local region and community. Dr. Moore is an Associate Professor at the University of Kentucky Healthcare. He is also the Co-CEO and Chief Financial Officer at Thoroughbred Emergency Physicians. He completed his residency in emergency medicine at the University of Alabama after graduating from the University of Kentucky Medical School in 2011, and he recently obtained his MBA from the University of Tennessee Knoxville. Dr. Moore’s Career Journey  Initially, after completing his residency, Dr. Moore had no intention of pursuing an academic career, preferring instead to work in community emergency medicine. However, after seeing the broken healthcare system in Kentucky and feeling compelled to address the issues, he decided to stay and do his best to fix the problems. He saw academia as a means to access resources and infrastructure to improve healthcare delivery.  Transitioning to a Large Academic Healthcare Organization Over time, Dr. Moore learned the importance of building credibility and success within projects to have a seat at the table for decision-making. Despite the slow pace of change, he was motivated by his goal to improve patient care and access.  Becoming a Change Agent Participating in emergency department management programs sparked Dr. Moore’s interest in operational change within healthcare systems. His introduction to business concepts came from reading literature and implementing strategies to address the challenges of high patient boarding rates and various other issues. His need for credentials and a desire to learn practical skills to navigate complex healthcare systems effectively drove him to pursue an MBA. Dr. Moore’s Approach to Public Health Emergencies Dr. Moore’s interest in addressing public health emergencies, particularly hepatitis C, arose from his commitment to providing high-quality care to every patient. His approach involved implementing standardized screening and treatment protocols within emergency departments, leveraging resources from organizations like Gilead Focus to support infrastructure development. Through perseverance and strategic planning, he aimed to implement systemic changes to improve healthcare outcomes for underserved populations. Annual Screening within High-risk Communities Dr. Moore emphasizes the importance of annual screening in high-risk communities, particularly in emergency departments. Despite lacking a defined screening cadence, he asserts that the current guidelines advocate for widespread screening, with minimal issues encountered with payers.  Financial Viability and Return on Investment Dr. Moore highlights the significant cost savings associated with early intervention and treatment, the economic benefits of proactive healthcare interventions, and the importance of incentivizing healthcare systems to prioritize preventive care initiatives. Expansion of Screening Initiatives Dr. Moore highlights the ongoing efforts to expand screening initiatives to other emergency departments and correctional facilities, emphasizing the need for scalable, replicable models of care. Expansion into Primary Care Offices While it's too early to assess the full effectiveness of expanding initiatives into primary care offices, initial indicators suggest increased case identification. However, challenges persist, highlighting the need for standardized protocols and a centralized team. Plans are also underway for a system-wide screening program, extending beyond the UK for the first time. Challenges with Er...

We are thrilled to have Dr. Bruce Meyer, Executive Vice President and Western Pennsylvania Market President for Highmark Health Network, back on the show today.  In today's discussion, we focus on graduate and undergraduate levels of medical education, exploring the repercussions of moving from a fee-for-service model to a value-based system and looking into the adaptations needed within medical education to align with this transition. Acute Care and Disease Management Despite recent shifts towards integrated curricula for medical education, the fundamental focus remains on acute care and disease management, with limited attention to preventive healthcare and wellness promotion. Bruce highlights the need to expand the curriculum to include preventive measures, mental health awareness, and addressing social determinants of health. Barriers to Curriculum Modification  A barrier to curriculum modification is the lack of training and education among current practitioners in value-based care, making it challenging to impart those principles to medical students and residents. Additionally, the economic incentives for practitioners often fail to align with the value-based care model. Rise of Alternative Practitioners The rise of alternative healers like naturopaths and holistic practitioners shows a gap in traditional medicine, which mainly deals with treating illnesses rather than overall well-being. The alternative healers approach preventive care holistically, promoting wellness in a way that the traditional model tends to overlook.  Need for Government and Payer Involvement  Bruce emphasizes the importance of both governmental and payer involvement in driving the shift toward value-based care in medical education. Government initiatives are essential due to their significant role in healthcare funding, while payers can incentivize practitioners to prioritize preventive care through financial incentives tied to outcomes. Reforming Medical Education Financing  The debt burden that medical students and residents carry poses a significant challenge, particularly in specialties with lower earning potential. That financial barrier discourages students from pursuing careers focused on preventive care and wellness. Addressing Economic Disparities  Bruce highlights the need to address the economic disparities between procedural and medical specialties because they influence career choices among medical students. Realigning financial incentives to reward practitioners for preventive care and promoting equity in reimbursement for medical services could help mitigate that issue. Procedural Specialists Hospitals value procedural specialists more because they bring in higher revenue, leading to higher salaries for those specialties than for primary care.  Limited Residency Positions  The proliferation of medical schools and insufficient graduate medical education slots exacerbate the limited residency positions problem. That has resulted in many American medical school graduates not securing residency spots despite promises of guaranteed training opportunities. Institutions Implementing Curriculum Changes Two institutions that have begun implementing curriculum changes to address these issues are Jefferson in Philadelphia and Allegheny Health Network. The changes include incorporating healthcare economics and business aspects into their curricula to prepare medical students and residents for the realities of the healthcare system. In Conclusion Ongoing attempts to improve medical education and training are crucial, with graduates from programs like Pemba having the potential to spearhead the change. Bruce emphasizes the importan...

We are delighted to have Dr. Bruce Meyer, Executive Vice President and Western Pennsylvania Market President for Highmark Health Network, joining us today to present Care Reimagined: A Healthcare System’s Transformation. Since joining Highmark Health in 2022, Bruce has been shaping and executing their payer-provider strategy in the Western Pennsylvania market. Before joining Highmark, he served as President of Jefferson Health in Philadelphia and held key executive positions at Thomas Jefferson University and UT Southwestern in Dallas.   As a respected author, educator, and alumnus of the Physician Executive MBA program at the University of Tennessee, Bruce brings his vast knowledge of clinical services, academic leadership, and healthcare administration to our discussion today. Obtaining an MBA from the Physician Executive MBA Program at the University of Tennessee  Recognizing the shift toward capitation in healthcare payment models, Bruce sought a program focused on the business of healthcare. Pemba stood out for its focus on healthcare management, providing him with a sophisticated toolkit for navigating the evolving healthcare landscape. Their reputation instantly elevated his career prospects, opening doors to new opportunities and leadership roles. Unanticipated Impact of the MBA Program Organizational development was an unforeseen but critical aspect of Bruce's MBA experience. Through the coursework and its practical application, he gained insights into the importance of developing people within organizations. That realization reshaped his leadership approach, transitioning from a subject matter expert to a team-oriented leader.  Addressing Unsustainability in Healthcare Economics The presentation begins by highlighting the unsustainable nature of healthcare economics in the United States, emphasizing the commonalities among developed healthcare systems worldwide, including service providers, innovators, and administrators, each contributing to the functioning and expenditure of the system.  Challenges in the Current Healthcare Landscape Bruce outlines the current economic challenges exacerbated by disproportionate growth in government payers like Medicare and Medicaid, which cover nearly 60% of healthcare costs. Shifting the costs onto commercial payers due to funding shortfalls further complicates the landscape. Additionally, the influence of polarized politics and increased government intervention in healthcare exacerbates existing issues, contributing to growing public distrust in the system. Transitioning Physician Employment and Financial Pressures on Hospitals There has been a significant shift in physician employment, with over 70% now employed by larger organizations rather than self-employed. This trend, coupled with private equity funding disruptive models, has led to financial hardships for hospitals, with a substantial percentage operating at a loss. Public trust in healthcare is also eroding due to perceived profit-taking by various stakeholders, including pharmaceutical companies, hospitals, and physicians. Factors Contributing to Escalating Healthcare Costs Bruce identifies several contributors to escalating healthcare costs in the US, including technological advancements, inflated drug and device development costs, administrative inefficiencies, and end-of-life care expenditures. Moreover, physicians in the US earn significantly higher salaries when compared with their counterparts in other developed countries. Addressing Waste and Inefficiencies in Healthcare The considerable waste and inefficiencies within the US healthcare system encompass administrative, clinical, operational, and social determinants of health costs. Issues such as gun violence, obesity, and homelessn...

We are delighted to have Dr. Karen Murrell and Dr. Chuck Noon joining us today. Dr. Murrell is a practicing emergency physician, Director of Care without Delay at Kaiser Permanente, and a LEAN expert and consultant. She is also a fellow of the American College of Emergency Physicians and a faculty member of ASAP Directors Academy. Dr. Murrell received an MBA from the University of Tennessee Pemba Program in 2009 and currently serves as a faculty member for the Institute for Healthcare Improvement, contributing to their hospital operations and emergency medicine courses.  Dr. Chuck Noon holds a Ph.D. in Industrial and Operations Engineering from the University of Michigan. As a professor at the University of Tennessee’s Haslam College of Business, he leads various executive MBA programs, including their Physician Executive MBA program. He is a LEAN expert and consultant at X32 Healthcare and a faculty member for the Institute of Healthcare Improvement, working toward perfecting their emergency department operations course. Navigating Leadership Challenges As Karen advanced in her emergency medicine career, the increasing volume of patients, long wait times, and a community crisis prompted her to seek solutions beyond traditional medical approaches. That led her to leverage LEAN principles and eventually enroll in the MBA program to gain a broader perspective of leadership and operations. Pursuing an MBA  Her desire to improve operations and enhance patient care, coupled with all the possibilities presented by LEAN methodologies, drove Karen to delve deeper into business education by pursuing an MBA at Pemba. The focus on physicians, global exposure, and the one-year duration of the program were additional factors that drew her in. Balancing Clinical and LEAN Work  Karen’s current career balance involves operating with a 50/50 split between clinical emergency medicine and LEAN work. Despite her demanding workload, she finds it rewarding to make a meaningful difference in patient care and work environments. She feels that her ability to blend clinical expertise with data analytics enhances the effectiveness of her performance improvement projects. Chuck's Evolution into Healthcare Improvement  After joining the University of Tennessee, Chuck transitioned from theoretical research to practical problem-solving in 1998, when they introduced their Physician Executive MBA program. His passion for making immediate and tangible improvements in healthcare operations led to his active involvement in LEAN methodologies. X32 Healthcare  Chuck co-founded X32 Healthcare in 2008 as a vehicle for LEAN education, analytic modeling, and on-the-ground consulting. Team Health bought the company in 2018 and continues contributing to healthcare improvement initiatives.  Consulting Engagements and Impact  Chuck and Karen engage in consulting work, contributing to various projects globally. In addition to working with Chuck, Karen has also visited Qatar three times over the last year to work on an initiative for the Institute for Healthcare Improvement. Chuck focuses on multi-faceted engagements, averaging four to six projects annually. Collaboratively, their approach enhances the effectiveness of LEAN initiatives. Multi-Pronged Approach to Improvement Chuck and Karen have collaborated to enhance patient flow and streamline processes in the emergency department of Boston Medical Center. Their comprehensive and multi-pronged approach involved assessments, data analysis, education, and improvement events. Using the example of their engagement with four hospitals in the Ontario province, Chuck emphasizes the importance of understanding barriers, identifying opportunities for improvement, and implementing targeted changes.

We are delighted to have Dr. Ram Raju, a dedicated leader in the healthcare industry, joining us for today’s discussion.  Dr. Raju was formerly the Senior Vice President and Chief Community Health Investment Officer at Northwell Health, the largest healthcare provider in New York. Before joining Northwell, he served as the President and CEO of New York City Health and Hospitals and the CEO of Cook County Health in Chicago.  Dr. Raju is a Pemba alumnus from the class of 2000 and received his CPE from AAPL. He has served on many local, regional, and national organizations. Throughout his career, he has passionately advocated for addressing population health issues, promoting equity in healthcare, and understanding the impact of social determinants on patients.  The topics we discuss today go far beyond quality in healthcare. We look into healthcare policy and the crucial role of physician leadership, and Dr. Raju shares valuable insights for those aspiring to leadership positions within healthcare organizations.  Dr. Raju brings a wealth of experience to our conversation today. You will not want to miss this opportunity to gain unique perspectives and recommendations from this recognized physician leader.  Current State of Healthcare Quality Dr. Raju explains that healthcare quality has evolved from a marketing tool to a commodity. As a result, he has noticed overall improvement in both quality and safety in the country. He suggests that future differentiation should include factors like cost-effectiveness, efficiency of care, and convenience for patients. The Definition of Quality  Quality in healthcare is not only about successful procedures. Dr. Raju advocates for a more comprehensive view of quality within healthcare, explaining that the focus needs to shift from treating diseases to treating individuals while considering the social determinants impacting each patient. That requires an understanding of the socio-economic conditions, living circumstances, and overall well-being of each patient. Physician Response to Social Determinants  Addressing the challenge of physicians incorporating social determinants into patient care, Dr. Raju suggests three strategies for improved patient outcomes: Utilization of data capturing social information Government reimbursement based on social risk A shift in the physician mindset to better understand patients beyond their diseases   Changing the Landscape of Quality Metrics  Discussing the evolution of quality metrics, Dr. Raju argues for a shift from disease-focused to patient-based outcomes, considering factors like patient satisfaction and overall well-being.  Equity in Healthcare and Policy Advocacy Highlighting the importance of understanding the integral role health policies play in healthcare, Dr. Raju underscores the need for physicians to get involved in advocating for policy changes. He teaches a course on policy and politics at the Roosevelt School of Public Policy, where he emphasizes the link between policy, politics, and achieving equity in healthcare. Redesigning Healthcare Delivery  Dr. Raju believes that training incoming doctors to prioritize health over disease management is crucial for the future. He calls for the healthcare delivery system to get redesigned and a shift from disease management to health-focused care.  Universal Healthcare and Insurance  Dr. Raju believes everyone should have healthcare insurance because that is an individual responsibility, like insuring cars or homes. He feels that insurance is essential to ensure careful and responsible healthcare consumption. Challenges and Opportunities in Healthcare Policy  Dr. Raju discusses the ongoi...

We are delighted to present an interview featuring Dr. Amit Prasad, the Chief Medical Officer of the Methodist Le Bonheur Hospital system.  In today’s conversation, Amit discusses his medical background and current responsibilities, and shares his thought-provoking perspective on the potential impact of artificial intelligence in the future of healthcare.  Join us as we explore the expertise and reflections of this distinguished leader in the medical field. Transitioning to Chief Medical Officer During COVID Amit has been the Chief Medical Officer for the Methodist Le Bonheur Hospital system for about two and a half years. He took on that role during the COVID surge, driven by his desire to be at the forefront of patient care, even though he was initially a Health Plan CMO.  Background as a Health Plan CMO Before becoming the Chief Medical Officer for the Methodist Le Bonheur Hospital system, Amit served as the Chief Medical Officer for the United Healthcare Mississippi Medicaid program for about three years. Transition Challenges During COVID During the early days of the COVID pandemic, Amit Dr. faced some unique setbacks, including limited face-to-face interactions due to mask mandates, making it challenging to establish connections and relationships. The Resilience of Healthcare Workforce During COVID Despite all the challenges, Amit acknowledges the resilience of the medical workforce during the pandemic. He is aware of the dedication and commitment of those who remained in healthcare at the time, going above and beyond to care for patients. Artificial Intelligence in Healthcare Amit explains that AI has an increasing role in various aspects of medicine, from analyzing data and interpreting physical exam findings to applications in imaging, robotic surgery, and documentation. It is also helpful for reducing variability in care and offering guideline-based recommendations. Potential Impact of AI on Clinical Decision Support Looking at the potential impact of AI on clinical decision support, especially in addressing diagnostic errors, Amit explains that AI could help providers, particularly in rural health settings, by offering guidance and guidelines for managing various conditions. Concerns and Downsides of AI in Healthcare Amit has some concerns about AI. They include the blind trust in AI tools, the potential for biased algorithms, the risk of data inaccuracy, and the liability implications. He emphasizes the need for clinicians to maintain control over AI and advocates for establishing guardrails and regulations. The Role of AI in Addressing Physician Shortages and Enhancing Efficiency AI can help address various challenges in healthcare, like physician shortages and burnout. Amit also sees AI playing a role in streamlining documentation processes, reducing administrative burdens, and improving the accuracy of medical records. Personal Journey into Leadership Roles Amit’s journey into leadership roles in healthcare began with a focus on diabetes management and performance improvement. His interest in leadership grew as he recognized the impact he could have on patient outcomes within those roles. Amit’s Future Aspirations Amit highlights the importance of focusing on healthcare beyond the hospital walls. While he remains content in his current position as Chief Medical Officer, he would still like to work on transitions of care and the entire continuum of patient care in the future.  Leadership Lesson: Empowering Teams for Patient Care Amit shares a leadership lesson. He points out that clinicians genuinely intend to do well for their patients, yet they might lack the...

We are delighted to share our live stream interview with Dr. Sandy Valino Stock today. Sandy is a family medicine practitioner and founder of a concierge direct primary care practice called EnVogue Med and Wellness. In our discussion, she shares her inspiring journey of moving through burnout to finding a practice model that reignited her passion for medicine by allowing her to use what she learned in the Pemba program to continue practicing medicine and bringing value and expertise to her patients. Founding EnVogue Med and Wellness  Sandy’s lingering desire to create a practice treating patients as consumers motivated her to found EnVogue Med and Wellness. Halfway through the Pemba program, she began to miss the clinical aspect of medicine. That led her to use the knowledge she gained from the program to return confidently to clinical medicine and establish her practice. Core Services of EnVogue Med and Wellness  The three core services offered by EnVogue Med and Wellness focus on an elevated patient experience, comprehensive primary care, and personalized medical weight management. Their unique approach involves longer appointments, direct messaging with doctors, and a membership structure covering non-insurance services. Business Growth and Future Services  Sandy’s plan for growing EnVogue Med and Wellness includes expanding to multiple Chicagoland locations to address the shortage of primary care providers and improve accessibility to quality healthcare. Future services may also include aesthetics, anti-aging, and personalized genetic medicine. Comparing Work Environments When comparing her workweek at EnVogue Med and Wellness with her previous workweeks in a traditional family medicine setting, Sandy says she prefers having the flexibility and varied responsibilities of her current workweek. As an entrepreneur, she wears many hats. That contributes to a more flexible and satisfying work-life balance. Integrating Lean Six Sigma into Practice Processes  Sandy explains that the organizational profile of Lean Six Sigma serves as a handbook, saving time and providing guidance. She believes integrating Lean Six into her medical practice will have a positive impact, as that approach helps her stay grounded as an entrepreneur and allows her to remain focused on her mission and vision. Patient Care and Practice Growth  As a new practitioner, about half of Sandy’s time involves direct patient care. She feels confident about the potential of the Direct Primary Care model to contribute to the healthcare landscape to eventually have a patient panel of 300 to 350, potentially expanding to 1000 patients. Insurance Acceptance  After initially opting out of Medicare, Sandy adapted to market demand and re-enrolled. Incorporating Direct Primary Care into her medical practice involved navigating legal structures to accommodate the different business models within her practice. Business Model Modifications and Flexibility  Sandy adopted an iterative approach to modifying her post-presentation business plan, experimenting with fee structures and remaining true to her mission. She highlights the importance of adaptability, employing a lean startup mentality, and continually tweaking the model to align with market needs. Impacting the Physician Shortage  Sandy envisions her model decreasing the physician shortage due to burnout by offering a more laid-back and consumer-centric approach. She anticipates it will retain physicians and positively influence the satisfaction of healthcare workers by contributing to a more sustainable and positive work culture. After-hours services and Patient Retention  Addressing the management of afte...

We are delighted to introduce Dr. Luissa Kiprono as our guest for today’s show. She is a physician leader, an entrepreneur, and the founder of two companies. She is also a motivational speaker and an author.  Dr. Kiprono is an alumnus of the University of Tennessee's Pemba program, where she graduated in 2020. She is board-certified. She completed her residency and OB-GYN and then did a maternal-fetal medicine fellowship at the University of Mississippi Medical Centre. She founded World Gateway Perinatal Consultants in 2018 and her Tele Med MFM Venture in 2022. She explores self-help and motivation through her recently published book, Push Then Breathe: Trauma, Triumph, and the Making of an American Doctor.  We are excited to dive into her work in telemedicine and explore how it influences her life and, more importantly, transforms the lives of her patients. Evolution of Telemed MFM Telemed MFM is a high-risk pregnancy care practice providing telemedicine solutions and maternal-fetal care access across geographical borders. Through virtual consultations, Dr. Kiprono addresses the current challenges in evaluation, assessment, and treatment delays, particularly in underserved rural areas. Her practice aims to bring high-risk medical care to expectant mothers, irrespective of where they are. Her commitment to consistency, discipline, and effective communication has contributed to her successful telemedicine practice. Lessons Learned and Empowerment Message Dr. Kiprono describes founding a telemedicine practice in her 50s as a simultaneously scary and exciting journey, particularly amid the COVID-19 pandemic and the closure of her former practice. She chooses a patient-driven approach over corporate healthcare norms and always encourages her fellow physicians to follow their hearts and pursue their dreams. Practicing Maternal Fetal Medicine Remotely In the earlier days, maternal-fetal medicine physicians provided prenatal care to high-risk patients in their offices and delivered the babies after nine months. However, a shift has occurred over the last decade due to the limited number of maternal-fetal medicine specialists (only about 313 out of 100 physicians are practicing full-time and boarded). That has evolved toward a more consultative approach, where physicians like Dr. Kiprono engage in virtual consultations, examine scans, and provide care through encrypted telehealth systems. Telemedicine MFM and Working with Hospital Systems Telemed MFM provides high-risk pregnancy care through telemedicine solutions. It also integrates into healthcare and hospital systems, offering services equivalent to an on-site presence. Dr. Kiprono decided to start the integration process into hospital systems by maintaining a full-time partnership with just one hospital system while contemplating the future expansion of her venture. She is currently working full-time with St. Luke's Health System in Kansas City, Missouri. Navigating Billing and Insurance in Telemedicine Dr. Kiprono explains that there has been a shift toward more streamlined and niche insurance coverage, making it more accessible and affordable. The hospital manages the billing for surgical and patient services, simplifying the process. Credentialing with various insurance companies is facilitated through the hospital. That also covers Dr. Kiprono’s services.  Expanding Telemedicine MFM and Future Plans Dr. Kiprono’s future vision for Telemedicine MFM includes recruiting additional physicians who share her commitment to virtual maternal-fetal medicine. While acknowledging the steep learning curve of telehealth, Dr. Kiprono remains optimistic about finding individuals comfortable with providing excellent medical care through virtual means. Pursuing an MBA in Physicia...

I am delighted to talk to Dr. Rinku Mehra today. She is a pediatric endocrinologist and is practicing currently in the Northern Virginia, DC metro area. Rinku’s Training and Career Evolution  Rinku did her training at Rush University and the University of Iowa and did a pediatric endocrinology fellowship at the University of Iowa. She is also a pediatric obesity medicine specialist. In her career, she has worked in academics and at the FDA and was the Medical Director for a large multi-specialty pediatric endocrinology group in Northern Virginia. She has also also worked in the payer space.  In her post-fellowship journey, starting in 2008, she faced the challenges of limited time for patient education, which highlighted the need for more personalized care and a deeper understanding of insurance models and motivated her to seek innovative solutions. Joining the Haslam College of Business in 2022 for an MBA was a pivotal factor that shaped her career path. Founding The Mehra Clinic Rinku is the CEO and Founder of The Mera Clinic, a telemedicine-based pediatric endocrinology practice spanning four states. She is on a mission to increase access to care, focusing on patients in Virginia, Maryland, Iowa, and Florida. Proposed Solutions To address the problems she identified, Rinku proposes a practice model that eliminates the need for referrals, provides flexible payment options, and ensures quick responses to patient queries. She emphasizes longer appointment times, tailored treatment approaches, and increased accessibility through text, email, and social media campaigns. Motivations for Concierge Medicine   Rinku's motivation for transitioning to concierge medicine was her dissatisfaction with the limitations of traditional healthcare. She wanted to reach a broader audience and deliver more personalized care. She also felt constrained by time within traditional practices, leading to burnout.  Rinku’s Financial Model  When comparing the financial model in her direct primary care practice with the traditional model, Rinku explains that she does not accept insurance directly when she practices across state lines. Patients pay her directly, and she provides super bills for reimbursement. Transparency is crucial in her model, avoiding hidden fees and passing on cost savings, especially for lab fees, to the patients. Work-Life Balance and Time Commitment  To maintain a work-life balance, Rinku aims never to exceed 200 patients, and her boundaries include working only during hours and then being available for emergencies. Having her patients respect her time has helped her maintain a balance. Marketing through Social Media  Rinku was initially uncomfortable about using social media for marketing. However, she now shares her monthly themed approach on platforms like Instagram, Facebook, and TikTok. She has a marketing expert and an assistant helping her to ensure the regular release of engaging content. Course Creation from Social Media Engagement Responding to comments and questions on social media led Rinku to create a comprehensive online course covering various health aspects for parents. The course emerged from her recognizing common misconceptions and the need for structured education. Serving Medicaid and Pursuing an MBA Leaving clinical practice, Rinku entered the corporate world, driven by a desire to make a broader impact on healthcare. With a focus on Medicaid and driven by her experiences as an immigrant, Rinku pursued an MBA to bridge the gap in her understanding of the business side of medicine. However, her frustration grew as she realized she could not influence decisions on matters she believed in, leading her to reconsider her directio...

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